Method and apparatus for treating urethral stricture

ABSTRACT

A mounting a treatment membrane to a delivery member includes wrapping the treatment membrane around the delivery member, pinching opposite overlapped edges of the treatment membrane together, and attaching the opposite overlapped edges of the treatment membrane together.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit under 35 U.S.C. §119(e) toU.S. Provisional Application No. 61/994,499 filed on May 16, 2014, theentire content of which is incorporated by reference herein.

TECHNOLOGICAL FIELD

The disclosure here pertains generally to a method and apparatus fortreating urethral stricture. More particularly, the disclosure isdirected to a trans-urethral urethroplasty method and apparatus.

BACKGROUND DISCUSSION

Known treatment options for urethral stricture, which is an abnormalnarrowing of the urethra, include urethroplasty surgery as well asminimally invasive procedures such as dilation, stent implantation, andurethrotomy. Due to the invasiveness of urethroplasty surgery, it isonly recommended in extreme cases of urethral stricture. However,minimally invasive procedures currently in use to treat urethralstricture can be of limited long-term effectiveness because they do notpromote epithelial function at the treatment site. Accordingly, a needexists for a practical, minimally invasive treatment of urethralstricture which promotes epithelial function at the treatment site.

SUMMARY

One aspect of the disclosure here involves a method of treating atreatment area of a body lumen, the method including inserting anelongated member into the body lumen, wherein the elongated member isconfigured to guide a delivery member, the delivery member possessing anouter portion on which is mounted a treatment membrane, moving thedelivery member to the treatment area, contacting the treatment membranemounted on the delivery member with the treatment area for apredetermined period of time, and withdrawing the delivery member fromthe treatment area after the predetermined period of time.

Another aspect involves a method of mounting a treatment membrane to adelivery member, the method including wrapping the treatment membranearound the delivery member, pinching opposite overlapped edges of thetreatment membrane together, and attaching the opposite overlapped edgesof the treatment membrane together.

A further aspect of the disclosure involves a method of delivering atherapeutic device to a treatment area of a body lumen, the therapeuticdevice including a) a delivery member possessing at least one attachmentpart and b) a treatment membrane, the method including wrapping thetreatment membrane on the delivery member, attaching the treatmentmembrane to the attachment part of the delivery member, and moving thedelivery member toward the treatment area.

An additional aspect of the disclosure involves a method of delivering atherapeutic device to a treatment area of a body lumen, the therapeuticdevice including a) a delivery member and b) a treatment membraneattached to the delivery member, the method including wrapping thetreatment membrane on the delivery member, moving the delivery membertoward the treatment area, detaching the treatment membrane from thedelivery member, and withdrawing the delivery member from the bodylumen.

BRIEF DESCRIPTION OF THE DRAWING FIGURES

Additional features and aspects of the method and apparatus for treatingurethral stricture disclosed here will become more apparent from thefollowing detailed description considered with reference to theaccompanying drawing figures in which like elements are designated bylike reference numerals.

FIG. 1 is a schematic illustration of an apparatus for delivering atreatment membrane to a treatment area.

FIGS. 2( a)-2(b) illustrate an exemplary delivery procedure using theapparatus of FIG. 1.

FIGS. 3( a)-3(c) illustrate an exemplary delivery procedure using theapparatus of FIG. 1.

FIGS. 4( a)-4(c) illustrate an exemplary delivery procedure using anapparatus for delivering a treatment membrane to a treatment area.

FIGS. 5( a)-5(d) illustrate an exemplary delivery procedure using theapparatus of FIGS. 4( a)-4(c) for delivering a treatment membrane to atreatment area.

FIGS. 6( a)-6(f) illustrate an exemplary delivery procedure using anapparatus for delivering a treatment membrane to a treatment area.

FIGS. 7( a)-7(d) illustrate an exemplary delivery procedure using anapparatus for delivering a treatment membrane to a treatment area.

FIGS. 8( a)-8(e) illustrate an exemplary delivery procedure using theapparatus of FIGS. 7( a)-7(d) for delivering a treatment membrane to atreatment area.

FIGS. 9( a)-9(e) illustrate an exemplary delivery procedure using anapparatus for delivering a treatment membrane to a treatment area.

FIGS. 10( a)-10(e) illustrate an exemplary delivery procedure using anapparatus for delivering a treatment membrane to a treatment area.

FIGS. 11( a)-11(e) illustrate an exemplary delivery procedure using anapparatus for delivering a treatment membrane to a treatment area.

FIGS. 12( a)-12(e) illustrate an exemplary delivery procedure using anapparatus for delivering a treatment membrane to a treatment area.

FIGS. 13( a)-13(b) illustrate an exemplary mounting procedure using anapparatus for mounting a treatment membrane to a delivery member.

FIGS. 14( a)-14(b) illustrate an exemplary mounting procedure using anapparatus for mounting a treatment membrane to a delivery member.

FIGS. 15( a)-15(b) illustrate an exemplary mounting procedure using anapparatus for mounting a treatment membrane to a delivery member.

FIGS. 16( a)-16(d) illustrate an exemplary mounting procedure using anapparatus for mounting a treatment membrane to a delivery member.

FIGS. 17( a)-17(c) illustrate an exemplary mounting procedure using anapparatus for mounting a treatment membrane to a delivery member.

FIGS. 18( a)-18(b) illustrate an exemplary attaching procedure using anattachment part of a delivery member.

FIGS. 19( a)-19(d) illustrate an exemplary attaching and detachingprocedure using an attachment part of a delivery member.

FIGS. 20( a)-20(b) illustrate an exemplary detaching procedure using anattachment part of a delivery member.

FIGS. 21( a)-21(c) illustrate an exemplary attaching and detachingprocedure using an attachment part of a delivery member.

FIG. 22 illustrates an attachment part of a delivery member.

FIGS. 23( a)-23(j) illustrate alternative attachment part embodiments.

FIGS. 24( a)-24(c) illustrate an exemplary method and apparatus forpositioning the delivery member relative to the treatment area.

FIGS. 25( a)-25(c) illustrate another exemplary method and apparatus forpositioning the delivery member relative to the treatment area.

FIGS. 26( a)-26(b) illustrate another exemplary method and apparatus forpositioning the delivery member relative to the treatment area.

FIGS. 27( a)-27(f) illustrate another exemplary method and apparatus forpositioning the delivery member relative to the treatment area.

FIGS. 28( a) and 28(b) illustrate exemplary methods for fixing theelongated member relative to the body lumen.

FIGS. 29( a)-29(h) illustrate an exemplary method and apparatus forattaching and detaching the treatment membrane with the delivery device.

FIGS. 30( a)-30(h) illustrate another exemplary method and apparatus forattaching and detaching the treatment membrane with the delivery device.

FIGS. 31( a)-31(c) illustrate another exemplary method and apparatus forattaching and detaching the treatment membrane with the delivery device.

FIGS. 32( a)-32(c) illustrate another exemplary method and apparatus forattaching and detaching the treatment membrane with the delivery device.

DETAILED DESCRIPTION

Set forth below is a detailed description of the method and apparatusfor treating urethral stricture disclosed here. The method and apparatusfor treating urethral stricture is described and illustrated in terms ofseveral embodiments disclosed as examples of the method and apparatusfor treating urethral stricture.

Generally speaking, embodiments of the method involve delivering atreatment membrane, such as buccal mucosa harvested from the inner cheekof the patient, preputium harvested from the patient, or any otherbiocompatible sheet, to the treatment area of the body lumen, i.e., thearea of urethral stricture in the patient's urethra. Prior to deliveryof the treatment membrane to the area of the urethral stricture, thearea is incised or dilated so that the treatment membrane receivessufficient nutrition for engraftment.

In embodiments of this method of treating the treatment area of the bodylumen, i.e., the urethra, an elongated member 10 is inserted into theurethra. In an embodiment, the elongated member 10 is an indwellingcatheter, as illustrated in FIG. 1. This elongated member 10 isconfigured to guide a delivery member 20 which possesses an outerportion on which is mounted a treatment membrane 30. In an embodiment,the treatment membrane 30 is buccal mucosa harvested from the patient'sinner cheek.

In an embodiment, the delivery member 20 is then moved to the treatmentarea 40, e.g., the area of urethral stricture in the patient's urethra.For example, in the FIG. 1 embodiment, the delivery member 20 is slidalong the outer surface of the elongated member 10 until it reaches thetreatment area. The delivery member 20 includes a fixing member capableof fixing the delivery member 20 to the elongated member 10. In variousembodiments discussed in detail below, the fixing member is anexpandable member.

Exemplary movements of the elongated member 10 and the delivery member20 in the insertion and moving steps are illustrated in FIGS. 2( a)-2(b)and in FIGS. 3( a)-3(c). In both procedures, in the step of insertingthe elongated member 10 into the urethra, the elongated member 10carries the delivery member 20 in an insertion direction. In the methodof FIGS. 2( a)-2(b), in the step of moving the delivery member 20 to thetreatment area 40, the delivery member 20 is moved in the insertiondirection, while in the method of FIGS. 3( a)-3(b), in the step ofmoving the delivery member 20 to the treatment area 40, the deliverymember 20 is moved in a direction opposite the insertion direction.Specifically, when the treatment area is located on the bulbar urethra,operator could easily deliver the delivery member by simply pushing thedelivery member toward the proximal end of the bulbar urethra whichlumen is narrow due to the external urethral sphincter. An X-ray markercan be incorporated into the delivery member 20 so that the operator candetermine the position of the delivery member 20 while it is beingmoved. The delivery member 20 can be moved relative to the elongatedmember 10 by operating an operation member 50 attached to the deliverymember 20. The operation member 50 can be, for example, a wire, asheath, and/or a tube for inflating the delivery member in embodimentsin which the delivery member is inflatable. The operation member 50 canbe attached to the delivery member 20, or separate from the deliverymember 20, in which case the operation member 50 is used as separatepusher and/or puller of the delivery member 20. In any event, theoperation member 50 is configured to be operable by the operatorseparately from the elongated member 10, such as by having a proximalend which remains outside the urethra.

In an embodiment, the outer portion of the delivery member 20 is pressedagainst the treatment membrane 30 to contact the treatment membrane 30with the treatment area for a predetermined period of time. In the FIG.1 embodiment, the delivery member 20 includes an expandable membercomprising an inflatable balloon 60 which is moved to the treatmentarea, and the step of pressing the outer portion of the delivery member20 against the treatment membrane 30 comprises expanding the expandablemember by inflating the inflatable balloon 60. The expandable member canalso be an inflatable sponge, or can operate by mechanical expansion,for example, in the manner of a stent.

After the predetermined period of time, the delivery member 20 iswithdrawn from the treatment area. The predetermined time is asufficient time for the treatment membrane 30, which is buccal mucosa inan embodiment, to graft to the treatment area due to pressure providedby the delivery member 20 and the pre-incision or pre-dilation of thetreatment area by a physician.

In the FIG. 1 embodiment, the delivery member 20 includes the expandablemember, and so the expandable member is moved to the treatment area atthe same time the delivery member 20 is moved to the treatment area 40.When using the apparatus of this embodiment, the step of pressing theouter portion of the delivery member 20 against the treatment membrane30 comprises expanding the delivery member. Additionally, in thisembodiment, after the predetermined period of time, the delivery memberis contracted and then the elongated member 10 is moved out of theurethra to carry the delivery member away from the treatment area andout of the urethra.

In an alternative embodiment illustrated in FIGS. 4( a)-4(c), thedelivery member 20 is attached to the expandable member. In theembodiment, the delivery member 20 is a curved plate which is attachedto an outer surface of the expandable member/inflatable balloon 60.Furthermore, the inflatable balloon 60 is operated and inflated througha balloon guide 70, which is, for example, a tube through which theballoon 60 can be inflated and which has a proximal end which projectsout of the urethra so that it can be independently operated by theoperator.

In further alternative embodiments, the apparatus can include anexpandable member which is an inflatable balloon 60 separate from thedelivery member 20. In this case, the expandable member/inflatableballoon 60 can be moved to the treatment area 40 before or after thedelivery member 20 is moved to the treatment area 40. Additionally, inthis case, to withdraw the delivery member after the predeterminedperiod of time, the expandable member 60, which is either kept at thetreatment area 40 while expanded during the predetermined time, or movedback to the treatment area 40 and expanded during or after thepredetermined period of time, can be moved out of the urethra to carrythe delivery member 20 away from the treatment area 40 and out of theurethra.

FIGS. 5( a)-5(d) illustrate such an embodiment in which, first, thedelivery member 20 is slid along the elongated member 10 to thetreatment area 40, and then the inflatable balloon 60 is slid along theelongated member 10 to the treatment area 40. The position of theinflatable balloon 60 relative to the delivery member 20 can bedetermined by, for example, comparing markings on the operation member50 and the balloon guide 70 which are disposed in relative positionswhich line up when the delivery member 20 and the inflatable balloon 60are at the same axial position. These markings can be, for example,X-ray markers on the operation member 50 and the delivery member 20.Alternatively, a structural positioning system, such as a stop on thedelivery member 20 configured to engage with the distal end of theinflatable balloon 60 to stop further movement of the inflatable balloon60 in the distal direction, can be provided for relative positioning ofthe inflatable balloon 60 relative to the delivery member 20.

In each of the embodiments which includes an expandable member such asan inflatable balloon 60, the apparatus can be configured so that, whenthe inflatable balloon 60 is expanded, relative sliding movement betweenthe delivery member 20 and the elongated member 10 in the axialdirection is prevented by virtue of the inflatable balloon 60 pressingon both the delivery member 20 and the elongated member 10. In each ofthe embodiments in which the elongated member 10 is a catheter, thecatheter's lumen allows urine to pass through the urethra when theinflatable balloon 60 is expanded. Additionally, in each case, towithdraw the delivery member after the predetermined period of time, theoperation member 50 is pulled to guide the delivery member 20 away fromthe treatment area 40 and out of the urethra.

In an alternative embodiment illustrated in FIGS. 6( a)-6(f), thedelivery member possesses an inner portion 80 separate from the outerportion which presses against the treatment membrane. This inner portion80 possesses a protrusion 90 which protrudes inwardly. The elongatedmember 10 possesses a groove 100 extending in an axial direction of theelongated member 10 and a plurality of spaced-apart notches 110 extendperpendicularly from the groove 100. In use, in the step of moving thedelivery member to the treatment area, the protrusion 90 slides withinthe groove 100 in the axial direction, and after this step, the deliverymember is rotated to cause the protrusion 90 to rotate into one of theplurality of notches 110, thereby preventing relative sliding movementbetween the delivery member and the elongated member in the axialdirection. Additionally, the step of pressing the outer portion of thedelivery member against the treatment membrane comprises moving theouter portion (which can have a curved plated shape such as shown in theFIG. 4 embodiment) relative to the inner portion 80 of the deliverymember having the protrusion. Alternatively, the step of pressing theouter portion of the delivery member against the treatment membrane cancomprise expanding an expandable member provided between the elongatedmember 10 and the delivery member.

FIGS. 7( a)-7(d) illustrate an embodiment in which the expandable memberis moved to the treatment area after the delivery member is moved to thetreatment area. In this embodiment, an endoscope 120 can be used as theelongated member to monitor the position of the delivery member 20relative to the treatment area 40, and so in some embodiments using theendoscope 120, x-ray markings are not used. However, some embodimentsuse both the endoscope 120 and x-ray markings for positioning.Additionally, in this embodiment, after the step of moving the deliverymember 20 to the treatment area 40, the elongated member/endoscope 120is withdrawn from the urethra. An elongated member 10 and inflatableballoon 60 are then moved, either sequentially or simultaneously, toposition the inflatable balloon relative to the delivery member 20. Theinflatable balloon 60 can be fixed to the elongated member 10 such thatthe elongated member 10 and inflatable balloon 60 are always movedsimultaneously, but this is not required The position of the inflatableballoon 60 relative to the delivery member 20 can be determined by, forexample, comparing markings on the operation member 50 and the balloonguide 70 which are disposed in relative positions which line up when thedelivery member 20 and the inflatable balloon 60 are at the same axialposition. These markings can be, for example, X-ray markers on theoperation member 50 and the delivery member 20. Alternatively, astructural positioning system, such as a stop on the delivery member 20configured to engage with the distal end of the inflatable balloon 60 tostop further movement of the inflatable balloon 60 in the distaldirection, can be provided for relative positioning of the inflatableballoon 60 relative to the delivery member 20.

The embodiment of FIGS. 8( a)-8(e) is similar to the embodiment of FIGS.7( a)-7(d) except that the outer portion of delivery member 20 (which isa curved plate in the embodiment) faces a side of the urethra oppositethe treatment area 40. This affords a clear view of the treatment area40 by the endoscope 120. In this embodiment, after the step of movingthe delivery member 20 to the treatment area 40 and before the step ofpressing the outer portion of the delivery member 20 against thetreatment membrane 30, the delivery member 20 is rotated to a positionin which the outer portion of the delivery member 20 faces the treatmentarea 40.

In the apparatus of the embodiment of FIGS. 9( a)-9(e), a one-wayexpandable member 150 is used as the delivery member, with the treatmentmembrane 30 being mounted to this one-way expandable member 150. Theone-way expandable member 150 has an annular inner surface that is fixedand an expandable annular outer surface. The one-way expandable member150 is removably mounted to an expandable intermediate member 160, whichis mounted to elongated member/endoscope 120. The expandableintermediate member 160 is a two-way expandable member in that itexpands at both its annular inner surface and its annular outer surface.

In the method illustrated in FIGS. 9( a)-9(e), before the step ofinserting the elongated member/endoscope 120 into the urethra, thedelivery member/one-way expandable member 150 is mounted onto theexpandable intermediate member 160 and the elongated member/endoscope120, and the expandable intermediate member 160 is expanded to preventrelative movement between the delivery member/one-way expandable member150 and the elongated member/endoscope 120. The elongated member 120 isthen moved in the axial direction to move the delivery member 150 andintermediate member 160 to the treatment area 40. The delivery member150 is then expanded to press the outer portion of the delivery member150 against the treatment membrane 30, thereby contacting the treatmentmembrane 30 with the treatment area 40. The intermediate member 160 isthen contracted, and the delivery member 150 is dismounted from theintermediate member 160 and the elongated member 120 by pulling back theelongated member 120, which still carries the intermediate member 160,thus leaving the delivery member 150 at the treatment area 40. Anindwelling catheter can then be inserted into the delivery member 150for urine drainage while the delivery member 150 is in position. Afterthe predetermined period of time, which, as discussed above, is asufficient time for the treatment membrane 30 to graft to the treatmentarea 40, the steps are reversed, i.e., the indwelling catheter isremoved, the intermediate member 160 is moved to the treatment area 40via the elongated member/endoscope 120 and expanded to prevent relativemovement between the delivery member 150 and the elongated member 120,the delivery member 150 is contracted, and then the elongated member120, with the intermediate member 160 and delivery member 150 mountedthereon, is removed from the urethra. An alternative process forremoving the delivery member 150 involves pulling on an operationmember, such as an inflation tube (not shown) attached to the deliverymember 150 and used for expanding and contracting the delivery member150.

FIGS. 10( a)-10(e) illustrate an embodiment of a method which uses asimilar apparatus as the embodiment of FIG. 9( a)-9(e). However, in themethod of FIGS. 10( a)-10(e), when the treatment area 40 is visiblethrough the elongated member/endoscope 120 and before the deliverymember 150 and intermediate member 160 reach the treatment area 40, theintermediate member 160 is contracted, and the delivery member 150 isdismounted from the intermediate member 160 and the elongated member 120and moved to the treatment area 40 via the operation member 50. Thedelivery member 150 can be moved to the treatment area 40, with theintermediate member 160, or, in alternative embodiment, without theintermediate member 160. The delivery member 150 is then expanded topress the outer portion of the delivery member 150 against the treatmentmembrane 30, thereby contacting the treatment membrane 30 with thetreatment area 40. As in the embodiment of FIGS. 9( a)-9(e), anindwelling catheter is inserted in the delivery member 150 and thedelivery member 150 is kept in position for the predetermined period oftime and removed after the predetermined period of time. The process forremoving the delivery member 150 from the treatment area 40 after thepredetermined period of time is the same as that described above withrespect to the embodiment of FIGS. 9( a)-9(e) such as by pulling on theunillustrated inflation tube attached the delivery member 150.

In the apparatus of the embodiment of FIGS. 11( a)-11(e), a two-wayexpandable member 170 is used as the delivery member, with the treatmentmembrane 30 being mounted to this two-way expandable member 170. Thetwo-way expandable member 170 expands at both its annular inner surfaceand its annular outer surface. The two-way expandable member 170 isremovably mounted to the elongated member/endoscope 120.

In the method illustrated in FIGS. 11( a)-11(e), before the step ofinserting the elongated member/endoscope 120 into the urethra, thedelivery member/two-way expandable member 170 is mounted onto theelongated member/endoscope 120, and the delivery member/two-wayexpandable member 170 is expanded to prevent relative movement betweenthe delivery member/two-way expandable member 170 and the elongatedmember/endoscope 120. The elongated member 120 is then moved in theaxial direction to move delivery member/two-way expandable member 170 tothe treatment area 40. The delivery member/two-way expandable member 170is then contracted to allow relative movement between the deliverymember/two-way expandable member 170. The delivery member/two-wayexpandable member 170 is then pulled back, resulting in dismounting ofthe delivery member/two-way expandable member 170 from the elongatedmember/endoscope 120, and then the delivery member/two-way expandablemember 170 is again expanded to press the outer portion of the deliverymember/two-way expandable member 170 against the treatment membrane 30,thereby contacting the treatment membrane 30 with the treatment area 40.An indwelling catheter is then inserted into the delivery member/two-wayexpandable member 170. After the predetermined period of time, which, asdiscussed above, is a sufficient time for the treatment membrane 30 tograft to the treatment area 40, the steps are reversed, i.e., theindwelling catheter is removed, the delivery member/two-way expandablemember 170 is contracted, the endoscope/elongated member is thenreintroduced into the delivery member/two-way expandable member 170 andthe delivery member/two-way expandable member 170 re-expanded, and thenthe elongated member/endoscope 120, with the delivery member/two-wayexpandable member 170 mounted thereon, is removed from the urethra. Inthe embodiment, the delivery member/two-way expandable member 170 may beremoved by pulling on the unillustrated inflation tube attached to thedelivery member/two-way expandable member.

The method illustrated in FIGS. 12( a)-12(e) is similar to thatillustrated in FIGS. 11( a)-11(e) except that the delivery member is aone-way expandable member 180 having a fixed outer surface, i.e., onlythe inner surface changes size to be able to mount to and dismount fromthe endoscope 120. The method of use is the same as that illustrated inFIGS. 11( a)-11(e) except that the delivery member/one-way expandablemember 180 is not re-expanded after removal of the elongatedmember/endoscope 120 until after the elongated member/endoscope 120 hasbeen reinserted into the delivery member/one-way expandable member 180for removal of the delivery member/one-way expandable member 180, or atall in the case in which the delivery member/one-way expandable member180 is removed by pulling on an unillustrated inflation tube attached tothe delivery member/one-way expandable member 180. In this embodiment,the delivery member/one-way expandable member 180 is large enough outerdiameter for successful engraftment of the treatment membrane 30 to thetreatment area 40.

In embodiments in which the delivery member is an expandable memberhaving an adjustable outer circumference, i.e., an expandable outersurface, in order to mount the treatment membrane 30 to the deliverymember/expandable member 200, the treatment membrane 30 is wrappedaround the expandable member 200, the opposite overlapped edges of theexpandable member 200 are pinched, and then the opposite overlappededges of the expandable member 200 are attached together by, forexample, suturing or heat sealing. FIGS. 13( a)-13(b) illustrate anexemplary process in which the pinching of the opposite overlapped edgesof the treatment membrane 30 together is done with a clip part 220 of aclip device 210. Alternatively, the treatment membrane 30 can first bewrapped around a mold and the opposite overlapped edges attachedtogether, then the mold is removed, then the treatment membrane 30mounted to the expandable member 200.

The circumference of the treatment membrane 30 can be set by setting thecircumference of the expandable member 200 to be the desiredcircumference of the treatment membrane 30. And by using a clip device210 which includes an indicator 230, such as a ruler which provides anindication of a size of the expandable member 200, as illustrated inFIGS. 14( a)-14(b), the expandable member 200 can be expanded during themounting process based on the indication. Furthermore, by using a clipdevice 210 which also includes a limiter 240 which limits the size ofthe expandable member 200, as illustrated in FIGS. 15( a)-15(b),expansion of the expandable member 200 can be automatically stoppedbased on a setting of the limiter 240.

As illustrated in FIGS. 16( a)-16(b), the clip device 210 can furtherinclude a cavity 250, in which case the method will further includepositioning the treatment membrane 30 and the expandable member 200 inthe cavity and, if necessary, expanding the expandable member 200 whilethe treatment membrane 30 and the expandable member 200 are positionedin the cavity 250. In an embodiment, a plurality of clip devices 210having different sized cavities can be made available, and thecircumference of the treatment membrane 30 can be set by selecting theclip device 200 having the appropriately-sized cavity.

The clip device 210 illustrated in FIGS. 16( a)-16(b) also possessessuturing holes 260 configured to align with the opposite overlappededges of the treatment membrane 30. When such suturing holes 260 areprovided, the opposite overlapped edges of the treatment membrane can beattached by performing a suturing operation through the suturing holes260. The clip device 210 illustrated in FIGS. 16( a)-16(b) furtherpossesses suturing holes 270 configured to align with opposite ends ofthe treatment membrane 30. When such suturing holes 270 are provided,the opposite ends of the treatment membrane can be at least partiallyclosed by performing a suturing operation through the suturing holes270. In more detail, as shown in the FIG. 16 c view of the bottom of theclip device 210, one suturing hole 270 is provided at each end of thebottom, while as shown in the FIG. 16 d view of the bottom of the clipdevice 210, two suturing holes are provided at each end of the top. Asuture passing through the suturing holes 270 of one end of the clipdevice 210 can tighten that end of the treatment membrane 30 around thatend of the expandable member 200. Since, as illustrated in FIG. 13( a),the expandable member 200 can have smaller-circumference ends serving asattachment parts, tightening each end of the treatment membrane 30around the smaller-circumference ends of the expandable member 200 canserve to immobilize the treatment membrane 30 with respect to theexpandable member 200. The treatment membrane 30 can then be releasedfrom the expandable member 200 at the appropriate time of the procedureby pulling on the strings which are used to provide the sutures throughthe suturing holes 270.

In the clip devices 210 described above, the clip part 220 of the clipdevice 210 possesses two opposed clip portions which are forced togetherby a spring force. With this configuration, the step of pinching theopposite overlapped edges of the treatment membrane 30 with the clippart 220 comprises providing a force which opposes the spring force tomove the opposed clip portions apart, moving the opposite overlappededges of the treatment membrane 30 to a pinching operation position, andreleasing the force which opposes the spring force to allow the springforce to force the opposed clip portions together at the pinchingoperation position to thereby pinch the opposite overlapped edges.

In an alternative embodiment, a clip device, such as the clip device 280illustrated in FIGS. 17( a)-17(c), can be provided, in which the clippart comprises completely separable opposed clip portions 290. With sucha clip device 280, the step of pinching the opposite overlapped edges ofthe treatment membrane 30 with the clip part comprises separating theopposed clip portions 290, moving the opposite overlapped edges of thetreatment membrane 30 to a pinching operation position, and bringing theopposed clip portions 290 together at the pinching operation position tothereby pinch the opposite overlapped edges. Furthermore, thecircumference of the treatment membrane 30 can be selected by selectingopposed clip portions 290 with the appropriately sized cavity portions300. A spring mechanism can also be used in this embodiment to assist inbringing the opposed clip portions 290 together.

The delivery member can also include attachment parts to assist inattaching and detaching the treatment membrane to and from the deliverydevice. In the embodiment illustrated in FIGS. 18( a)-18(b), thedelivery member/expandable member 200 includes an attachment part 310 ateach end, and the opposite edges of the treatment membrane 30 aresutured directly to the attachment parts 310. FIGS. 19( a)-19(d)illustrate a similar embodiment in which the treatment membrane 30 isattached to each attachment part 320 by virtue of suturing oppositeedges of the treatment membrane such that openings are defined throughwhich the attachment parts 320 protrude. The curved shape of theattachment parts 320 assists in keeping the treatment membrane 30attached even though it is not directly sutured to the attachment parts320 in this embodiment. In these embodiments, the delivery member 200and attached treatment member 30 can be considered to togetherconstitute a therapeutic device.

As illustrated in FIG. 19( d), in the embodiment in which curvedattachment parts 320 are used, the delivery member 200 be rotated tocause the curved attachment parts to 320 retract through the openingsdefined by the sutures and thereby detach the treatment membrane 30 fromthe delivery member 200. The delivery member 200 can then be withdrawnfrom the urethra. Furthermore, in embodiments in which the deliverymember 200 is an expandable member, the expandable member canadditionally or alternatively be contracted in the detachment process,as illustrated in FIGS. 20( a) and 20(b).

FIGS. 21( a)-21(c) illustrate a further embodiment in which eachattachment part 330 is formed as two oppositely curved portions, and thetreatment membrane 30 is detached by rotating the delivery member 200 infirst one direction, and then the other direction.

FIG. 22 illustrates an alternative embodiment in which the attachmentparts comprise slits 340 in the delivery member 200. Such slits 340 canbe configured to engage portions of the treatment membrane 30 or suturesin the treatment membrane 30, and can detach from such portions byrotating the delivery member 200.

Further alternative embodiments of attachment parts include tabs forsuturing opposite ends of the treatment membrane thereto illustrated inFIG. 23( a), tips for piercing opposite ends of the treatment membraneas illustrated in FIG. 23( b), hooks for hooking across the treatmentmembrane as illustrated in FIGS. 23( c) and 23(d), and straightattachment parts, such as those illustrated in FIGS. 18 a) and (18 b)but provided across the treatment membrane as illustrated in FIG. 23(e). Additionally, the attachment parts can be strings for bindingopposite ends of the treatment membrane as illustrated in FIGS. 23( f)and 23(g), suction cups for suctioning opposite ends of the treatmentmembrane as illustrated in FIG. 23( h), adhesive sheets for adhering toopposite ends of the treatment membrane as illustrated in FIG. 23( i),and suction holes for suctioning across the treatment membrane asillustrated in FIG. 23( j). The various attachment parts can be locatedon opposite ends of the treatment membrane, across the treatmentmembrane, or both.

Various methods for ensuring that the delivery member is provided at thedelivery area are discussed above. Additional methods which can beadapted to the previously discussed embodiments are illustrated in FIGS.24-28.

In the method illustrated in FIGS. 24( a)-24(c), prior to insertion ofthe elongated member and delivery member into the urethra, a measuringmember 400, such as a wire or tube with a blunt distal end andmeasurement markings starting from the distal end, is inserted into theurethra until its distal end reaches the subject's bladder neck 450 (asdetermined by resistance of the measuring member 400 to furtherinsertion). An endoscope 120 is then used to view the measurementmarkings next to the treatment area 40. Such measurement markings can beused to determine the length between the bladder neck 450 and thetreatment area 40. Next, the delivery member 20 is fixed to theelongated member 10 at an appropriate position based on the known lengthfrom the bladder neck 450 to the treatment area 40 which would cause thetreatment membrane 30 to line up with the treatment area 40 when theblunt distal portion of the elongated member 10 reaches the bladder neck450. Measurement markings can be provided on the elongated member 10 forpositioning of the delivery member 20 relative to the elongated member10.

In the method illustrated in FIGS. 25( a)-25(c), prior to insertion ofthe elongated member and delivery member into the urethra, a measuringmember 500, such as a wire or tube or sheath with measurement markingsstarting from the distal end, is inserted into the urethra until itsdistal end reaches the treatment area 40, as determined by an endoscope120. The operator can then use the measurement markings on the measuringmember 500 to visually determine the length from the treatment area tothe external urethra meatus 550. With this information, the operator canmore precisely position the delivery member 20 and treatment membrane30. For example, in an embodiment in which the elongated member 10 isinserted into the urethra, and then the delivery member 20 moved alongthe elongated member 10, measurement markings on the operation member 50can be used to determine that the delivery member 20 has moved withinthe urethra the same length as the length between the treatment area 40and the external urethra meatus 550. In this case, the delivery member20 will have been moved to the treatment area 40. The operator can alsodetermine the length between the treatment area and another anatomicallandmark. The anatomical landmark includes, for example, the bladderneck, the external urethra meatus, or the membranous urethra. Afterthese steps, the delivery member 20 is fixed to the elongated member 10to avoid unexpected movement of the treatment membrane mounted on thedelivery member from the treatment area 40 during the predeterminedperiod of time.

The proper positioning of the delivery member 20 can also be monitoredby using a clear indwelling catheter for the elongated member 10 andproviding an endoscope 120 within the clear indwelling catheter so thatthe operator can visually determine that the delivery member 20 has beenprovided at the treatment area. Alternatively, as illustrated in FIGS.26( a)-26(c), a clear indwelling catheter having measurement markingsstarting from the blunt distal end can be used as the elongated member10. In this method, the distance between the bladder neck and thetreatment area 40 is first measured, for example, in the mannerdescribed with respect to FIG. 24( a). Then, the endoscope 120 can beprovided within the inserted elongated member 120 to view the positionof the delivery member relative to the measurement markings on theelongated member 120 to help with proper positioning of the deliverymember 20 relative to the treatment area 40.

Another type of clear elongated member that can be used as a deliverymember is a clear sheath 600, as illustrated in FIGS. 27( a)-27(f). Themethod in this embodiment is similar to the method used in FIGS. 11(a)-11(f) except that, instead of being mounted directly to the endoscope120, the delivery member 170 is mounted to the clear sheath 600, and theendoscope 120 is positioned within the clear sheath 600 to view theposition of the delivery member 170 relative to the treatment area 40.When the endoscope 120 is withdrawn, the clear sheath 600 remains. Afterthe indwelling catheter 650 is inserted into the clear sheath 600 andthe delivery member 170, the clear sheath 600 is withdrawn.

FIGS. 28( a) and 28(b) illustrate methods for fixing the position of theelongated body/indwelling catheter 10 relative to the treatment area 40.In FIG. 28( a), a stopper 700 is fixed to the appropriate position onthe elongated body/indwelling catheter 10 to engage with the externalurethra meatus. In more general terms, the elongated body 10 is fixed toat least one side of the edge of the body lumen. This can also beaccomplished by suturing the external urethra meatus to the side of theelongated body 10, as illustrated in FIG. 28( b). Additionally oralternatively, the distal end of the elongated body/indwelling catheter10 can be fixed relative to the bladder neck 450 by, for example,hooking or hanging. Fixation of the delivery member 20 to the elongatedbody/indwelling catheter 10 further ensure to avoid unexpected movementof the treatment membrane mounted on the delivery member from thetreatment area 40 during the predetermined period of time.

FIGS. 29( a)-29(h) and 30(a)-30(h) illustrate alternative methods ofattaching and detaching the treatment membrane 30 with the deliverymember 20 using a snare device. In FIGS. 29( a)-29(h), the snare device800 is a string extending back and forth through a pipe and looped atone end. Pushing and pulling the string at the other end of the pipeincreases and decreases the size of the loop. In the illustratedembodiment, the loop is provided around the distal end of the treatmentmembrane and pulled tight to contract that end of the treatment membranearound one of the smaller-circumference ends of the delivery member (thedistal end in the embodiment). At the appropriate time, the loop isexpanded to detach the treatment membrane 30 from the delivery member20. In the method of FIGS. 30( a)-30(h), a snare device 850 having twoloops to snare both smaller-diameter ends of the delivery member 20 isused. In this embodiment, as an alternative to expanding the loops todetach the treatment membrane 30 from the delivery member 20, the loopscan instead be cut.

Alternatively, as illustrated in FIGS. 31( a)-31(c), snare loops 900 canbe formed by providing openings 950 in the smaller-circumference ends ofthe delivery member 20 and running strings through the respective setsof openings 950. By pulling both strings for a particular loop, thatloop can be tightened to attached the treatment membrane 30 to thedelivery member 20. At the appropriate time, a single string for eachloop can be pulled to remove the strings entirely and allow thetreatment membrane 30 to detach from the delivery member.

As a further alternative, one or more puncturing members 1000 can beprovided on the delivery member 20, as shown in FIGS. 32( a)-32(c). Whenthe delivery member 20 is expanded, the puncturing devices 1000 puncturethe treatment membrane to attached the treatment membrane 30 to thedelivery member 20. The puncturing devices 1000 can also be configuredto puncture the wall of the urethra. In this embodiment, in order todetach the treatment membrane 30, the delivery member 20 is contractedto pull the puncture devices 1000 out of the treatment membrane 30and/or the wall of the urethra.

The detailed description above describes features and aspects ofembodiments of a trans-urethral urethroplasty method and apparatusdisclosed by way of example. The invention is not limited, however, tothe precise embodiments and variations described. Changes, modificationsand equivalents can be employed by one skilled in the art withoutdeparting from the spirit and scope of the invention as defined in theappended claims. It is expressly intended that all such changes,modifications and equivalents which fall within the scope of the claimsare embraced by the claims.

What is claimed is:
 1. A method of mounting a treatment membrane to adelivery member, the method comprising: wrapping the treatment membranearound the delivery member; pinching opposite overlapped edges of thetreatment membrane together; and attaching the opposite overlapped edgesof the treatment membrane together.
 2. The method of claim 1, furthercomprising adjusting an outer circumference of the delivery member andsetting a circumference of the treatment membrane by setting the outercircumference of the delivery member.
 3. The method of claim 2, whereinthe delivery member comprises an expandable member.
 4. The method ofclaim 1, wherein the step of pinching opposite overlapped edges of thetreatment membrane together comprises pinching the opposite overlappededges of the treatment membrane with a clip part of a clip device. 5.The method of claim 3, further comprising, before attaching the oppositeoverlapped edges of the treatment membrane together, expanding theexpandable member.
 6. The method of claim 4, wherein the clip devicefurther comprises a cavity, and the method further comprises positioningthe treatment membrane and the delivery member in the cavity.
 7. Themethod of claim 6, wherein an inner circumference of the cavity isadjustable, and wherein the method further comprises setting acircumference of the treatment membrane by setting the innercircumference of the cavity.
 8. The method of claim 4, wherein the clippart of the clip device possesses suturing holes configured to alignwith the opposite overlapped edges of the treatment membrane, and thestep of attaching the opposite overlapped edges of the treatmentmembrane together comprises performing a suturing operation through thesuturing holes.
 9. The method of claim 3, wherein the step of pinchingopposite overlapped edges of the treatment membrane together comprisespinching the opposite overlapped edges of the treatment membrane with aclip part of a clip device.
 10. The method of claim 9, wherein the clipdevice further comprises an indicator for providing an indication of asize of the expandable member, and the method further comprisesexpanding the expandable member based on the indication.
 11. The methodof claim 9, wherein the clip device further comprises a limiter forlimiting a size of the expandable member, and the method furthercomprises stopping expansion of the expandable member based on a settingof the limiter.
 12. The method of claim 4, wherein the clip part of theclip device possesses suturing holes configured to align with oppositeends of the treatment membrane, and the method further comprises atleast partially closing the opposite ends of the treatment membrane byperforming a suturing operation through the suturing holes.
 13. Themethod of claim 4, wherein the clip part of the clip device possessestwo opposed clip portions which are forced together by a spring force,and the step of pinching the opposite overlapped edges of the treatmentmembrane with the clip part comprises providing a force which opposesthe spring force to move the opposed clip portions apart, moving theopposite overlapped edges of the treatment membrane to a pinchingoperation position, and releasing the force which opposes the springforce to allow the spring force to force the opposed clip portionstogether at the pinching operation position to thereby pinch theopposite overlapped edges.
 14. The method of claim 4, wherein the clippart of the clip device possesses two opposed clip portions which areseparable, and the step of pinching the opposite overlapped edges of thetreatment membrane with the clip part comprises separating the opposedclip portions, moving the opposite overlapped edges of the treatmentmembrane to a pinching operation position, and bringing the opposed clipportions together at the pinching operation position to thereby pinchthe opposite overlapped edges.
 15. The method of claim 1, wherein thestep of attaching the opposite overlapped edges of the treatmentmembrane together comprises heat sealing the opposite overlapped edgesof the treatment membrane together.
 16. The method of claim 1, whereinthe step of attaching the opposite overlapped edges of the treatmentmembrane together comprises stapling the opposite overlapped edges ofthe treatment membrane together.
 17. The method of claim 1, furthercomprising, before wrapping the treatment membrane around the deliverymember, wrapping the treatment membrane around a mold and then providingthe treatment membrane at the delivery member.